Download MBBS Surgery Presentations 6 Approach To A Neck Mass Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Surgery 6 Approach To A Neck Mass PPT-Powerpoint Presentations and lecture notes


Approach to a Neck Mass

Objectives

? Develop a Diagnostic Approach

? Review Differential Diagnosis

? Case-Based Review
History ? Important Points

? Mass itself:

? Duration, ? Size or character change since noticed

? Associated symptoms:

? Pain, sensory loss, epistaxis, dysphagia, hoarseness,

hemoptysis, cold/heat intolerance, hearing change...

? Social history:

? Smoking, chewing tobacco, alcohol

? Past medical history

? Radiation*, skin cancer/lesion

? Family history *

Physical Examination

? Take the time to be thorough

? Inspection:

? Exterior scalp, face, ear

? oropharnyx, hypopharnyx, larynx, nasal passage

? External Ear

? Flexible fiberoptic endoscopy

? Palpation -- External & Bimanual

? Mass, thyroid, lymph node levels, oropharnyx,

salivary glands

? Relation to swallowing/tongue protrusion
Fine Needle Aspiration

? Often the first diagnostic test
? Simple and highly sensitive
? No longer felt to risk spread of tumor
? Technically demanding sometimes *
? Don't forget US guidance can be helpful
? Cytopathologist is key

Lab Tests & Imaging

? Play a smaller role than usual
? Blood work??
? C.T. scanning

? Large/complicated mass
? ? Remote primary
Differential Diagnosis Simplified

? Congenital Lesions *
? Salivary Gland Lesions *
? Thyroid Gland Lesions *
? Lymph Nodes *

Triangles

of the

Neck

Anterior

Submandibular

Submental

Carotid

Posterior
Triangles of the Neck

? Anterior

? Submandibular

? Submandibular gland

? Submental

? Dermoid, ranula

? Carotid

? Branchial cleft cyst, Carotid Body Tumour

? Posterior

? Lipoma, Neurogenic tumor

? * Lymph node lesions can be anywhere *

Lymph Nodes

? Inflammatory
? Lymphoma
? Metastatic

? Site of the node can help localize the primary
? Supraclavicular nodes can be non head & neck 10

? Breast & Lung most common
? GI tract, Prostate, Testicular
? Eponym*
Lymph

Node

Levels

Memorial

Sloan-

Kettering

Lymph Node Level

Likely Primary Site

Cases

7 Year Old Boy

? Small lump middle of neck
? Asymptomatic
? Otherwise healthy
? Physical

? 1.5cm, firm lump middle neck
? Moves up with tongue protrusion

? What now?

? ? FNA ? Eponym
65 Year Old Man

? Asymptomatic 2 cm lump Right submandibular

triangle

? Chews tobacco, no EtOH
? Remainder history negative
? Physical

? 2 cm firm lump ? Submandibular gland on Bimanual
? Remainder negative

? FNA ? Mucoepidermoid Ca
? What now?

38 year old Woman

? Asymptomatic
? Referred by GP for neck nodes
? History entirely negative
? Physical

? Multiple nodes levels 3 & 4 Right side
? Small nodule Right Thyroid

? Likely Diagnosis?
? FNA ? Papillary Ca
? What now?
56 Year Old Man

? Asymptomatic Lump Left Neck
? Heavy Smoker, occasional EtOH
? No past history or family history
? Physical Exam

? Hard lump L neck anterior triangle
? Otherwise negative despite being thorough

? FNA ? Squamous Cell Carcinoma
? What Now?

A 43-year old man notes shortness of breath. He

is a non smoker. His wife points out that his face

has become slightly swollen. On examination, his

blood pressure is normal. His pupils are equal and

respond to light. Dilated veins are noted around

the shoulders, upper chest, and face. An x-ray of

the chest reveals an opacity in the superior

mediastinum. What is the most likely diagnosis?

(A) Thymoma

(B) Neurogenic tumor

(C) Lymphoma

(D) Teratodermoid tumor




This 19 year old girl had a

two-week history of a

painless swelling in the left

jugulo digastric region.

FNAC demonstrated benign

squamous cells, cellular

debris and cholesterol

crystals. CT scan

demonstrated a well

circumscribed cystic mass,

anterior to the

sternomastoid muscle. This

is a typical ?

This young woman had a

one-week history of a

rapidly enlarging mass in

the upper right neck with

localised tenderness. The

CT scan again

demonstrates a well

circumscribed unilocular

cyst, with a smooth wall


This young man has a

prominent painless lymph node

in the jugulodigastric region.

Fine needle aspiration biopsy

indicated a diagnosis of

Hodgkin's Disease. The 40

year old man (inset) has a lump

in an identical position, also

painless and present for months.

Fine needle aspiration biopsy

confirmed the diagnosis of

metastatic squamous cell

carcinoma from a tonsil cancer.

He was a non smoker.

The man is 60, a heavy smoker

and presents with a hoarse

voice and large mass in the

right upper neck. Fine needle

aspiration biopsy showed

necrotic debris and the CT scan

demonstrates a unilocular

cystic mass. The cyst wall is

irregular and this is metastatic

squamous carcinoma, which

has undergone cystic

degeneration. The primary

cancer was in the hypopharynx


This man has

nasopharyngeal carcinoma

with multiple metastatic

lymph nodes in the

posterior triangle,

bounded by the clavicle

below, sternomastoid

muscle anteriorly and the

trapezius posteriorly..

The young man had a

firm, but not hard

submandibular swelling

which had been present

for 5 years. The CT scan

on the right demonstrates

a midline dermoid cyst.

This is a well localised

benign congenital lesion.


This young woman, aged

25, has a well localised

swelling just below the

hyoid bone, which elevates

on protrusion of the tongue.

The CT scan on the right is

from another patient but

demonstrates identical

pathology of a well

circumscribed cystic

structure lying anterior to

the thyroid cartilage -

thyroglossal cyst.

This young woman has a

prominent right thyroid

nodule. The appropriate

investigations are FNAB

and serum TSH.




This boy, aged 14,

presented with a cystic mass

in the left submandibular

region. Needle biopsy

demonstrated the presence

of mucoid material and the

CT scan shows a cystic

mass lying anterior to the

left submandibular salivary

gland. This is a typical

plunging ranula and is due

to extravasation of mucoid

saliva from the sublingual

gland

This elderly man has a

large left submandibular

mass. An SCC of the

cheek was removed a year

earlier. FNAB showed

metastatic SCC and the

CT scan demonstrates a

large cystic mass with a

septum, consistent with

metastatic cancer.


This 45 year old Asian

woman, recently migrated

to Australia, presented

with a supurating mass in

the right submandibular

region. A diagnosis of

tuberculosis was made

following culture of tissue

from the mass

Questions/Comments

This post was last modified on 08 April 2022